MEDICARE: DYNAMIX REHABILITATION SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070013646	IL

General Provider Information

NPI Number	:	1437489796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIX REHABILITATION SERVICES, INC.

Provider Business Mailing Address
First Line	:	3206 RFD
Second Line	:
City	:	LONG GROVE
State	:	IL
Zip	:	60047-8352
Country	:	US
Telephone Number	:	847-452-3403
Fax Number	:	847-745-0546

Provider Business Practice Location Address
First Line	:	3206 RFD
Second Line	:
City	:	LONG GROVE
State	:	IL
Zip	:	60047-8352
Country	:	US
Telephone Number	:	847-452-3403
Fax Number	:	847-745-0546

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MARINA ARDASHNIKOVA
Credential	:	M.D.
Telephone Number	:	847-736-9254

Provider Enumeration Date	:	01/10/2010
Last Update Date	:	01/10/2010

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